Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge
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ORIGINAL ARTICLE
Patient‑reported outcomes of ductoscopy procedures for pathologic nipple discharge M. D. Filipe1 · J. M. Simons1 · L. Moeliker1 · L. Waaijer1 · M. R. Vriens1 · P. J. van Diest2 · A. J. Witkamp1 Received: 30 April 2020 / Accepted: 2 November 2020 © The Author(s) 2020
Abstract Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications. Keywords Quality of life · Ductoscopy · Pathologic nipple dischage
Introduction Pathologic nipple discharge (PND) is the third most common breast-related complaint, after pain and palpable lumps [1]. PND is defined as unilateral, spontaneous and bloody or serous discharge, usually arising from a single duct orifice of the nipple. PND is regarded as a possible sign of breast * M. D. Filipe m.d.filipe‑[email protected] A. J. Witkamp [email protected] 1
Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands
Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
2
cancer and it accounts for 3–5% of surgical breast clinic referrals [2–5]. Ultrasound, mammography and magnetic resonance imaging (MRI) often fail to reveal the underlying cause of PND [6, 7]. Therefore, most women suffering from PND undergo invasive surgical procedures, such as microdochectomy or major duct excision, to rule out malign
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